Upper Extremity Flashcards
Anatomy of the Upper Extremity
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Shoulder:
4 joints: Sternoclavicular, acromioclavicular, glenohumoral, scapulothoracic (thoracuscapular)
· Most unstable collection of joints in the body
· Need to know landmarks: Clavicle, Scapula, Acromion, Coracoid process, Spine of scapula, Vertebral border, Humerus, Greater tuberosity, Bicipital groove
Elbow:
· Comprised of 3 joints: Humeroulnar joint, Humeroradial joint, Radioulnar joint
· Bones/landmarks to know: Humerus, Olecranon, Head of radius
Wrist & Fingers:
Distal interphalangeal joint, proximal interphalangeal joint, metacarpophalangeal joint.
Normal planes of movement of each of the upper extremity joints. Degree of range of motions
Shoulder: ● Flexion 150 deg ● Hyperextension 40 deg ● Abduction 150 deg ● Adduction 30 deg ● Internal rotation 70 ● External rotation 90 Elbow: ● Flexion 150 ● Hyperextension 5 ● Pronation 80 ● Supination 80 Wrist: ● Flexion 80 ● Hyperextention 70 ● Radial deviation 20 ● Ulnar deviation 30 Fingers: ● Flexion 90 ● Hyperextension 30 ● Opposition ● Abduction ● Adduction
Appropriate examination techniques and sequence of examination for the upper extremity
Inspection
Palpation
ROM
Muscle strength
Scapular winging
Patient does push up or pushes out against wall, with shoulders retracted, ‘wings’
Associated condition:Weakness for serratus anterior muscle, or palsy of the long thoracic nerve
Drop arm test
Abducted arm, ask to slowly lower (+) for tears, arm will drop and will not be lowered in a slow, smooth fashion
Associated condition: tears in rotator cuff (usually supraspinatus)
Yergason test
Grasp flexed elbow, hold wrist and externally rotate arm with resistance and pull down (+) tendon will pop out and patient will have pain.
Associated condition: biceps tendinitis (may result from rotator cuff dysfunction/ impingement, almost always involves long head of biceps tendon)
Apprehension test
Patient lies supine w/ shoulder abducted 90 degrees, max external rotation
Examiner supports the humerus while applying overpressure to the externally rotated shoulder
(+) is patient is apprehensive (reacts/painful)
Associated condition: Chronic shoulder dislocation
Tennis elbow test (lateral epicondylitis)
Patients elbow flexed 90 degrees
Stabilize forearm and instruct patient to make a fist and extend the wrist
Apply pressure to the dorm of the fist and attempt to force wrist into flexion
Severe pain at lateral epicondyle (+)
Associated condition: Lateral epicondylitis (pain in the extensor tendons that originate at the lateral epicondyle, overuse syndrome)
Tine sign - elbow/wrist
(+) neuroma, tapping area of nerve between olecranon and medial epicondyle, tingling sensation down forearm (ulnar side)
Associated condition: Cubital tunnel syndrom (ulnar nerve entrapment at elbow)
Allen test
Palm up, compress radial and ulnar artery, patient open/close fist, please ulnar artery and watch for palmar repercussion, repeat with radial
Associated condition: patency of ulnar and radial arteries
Finkelstein test
Make a fist, thumb tucked in, stabilize forearm, deviate wrist to ulnar side with other hand, (+) sharp pain in tunnel = stenosing tenosynovitis
Associated condition: DeQuervain’s tenosynovitis (tunnel 1 - thumb, repetitive motion injury)
Phalen test
Flex patient wrist to maximum degree and hold for 1 minute, (+) tingling of fingers
Associated condition: Carpel Tunnel (compression of median nerve under the transverse carpal ligament, overuse syndrome)
Deep tendon reflexes of the upper extremity and the cervical nerve associated with each
Biceps reflex: C5
Brachioradialis reflex: C6
Triceps reflex: C7
Assessment of sensory enervation for the upper extremities
-Shoulders: Assessment: sharp, soft and dull on all dermatomes.
Cervical nerve: supraclavicular nerve C3-C4, axillary nerve C5-C6
-Elbows: Assessment: sharp, soft and dull on all dermatomes.
Cervical nerve: lateral antebrachial cutaneous nerve C5-C6, medial antebrachial cutaneous nerve C8-T1, posterior antebrachial cutaneous nerve C5-C6,
-Wrists: Assessment: sharp, soft and dull on all dermatomes.
Cervical nerve: musculocutaneous nerve C6, radial nerve C6-C7, median nerve C5-C8, median antebrachial nerve C8-T1
-Hands: Assessment: sharp, soft and dull on all dermatomes. Test sensation of vibration on DIP with the low frequency fork. Test proprioception.
Cervical nerve: radial nerve C6-C7, ulnar nerve C8-T1, median nerve C5-C8
Assessment of sensory enervation of the dermatomes
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